Healthcare Provider Details

I. General information

NPI: 1316221070
Provider Name (Legal Business Name): GREGG S. GRIFFIN, D.C., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N MAIN ST
CLYDE OH
43410-1215
US

IV. Provider business mailing address

819 N MAIN ST
CLYDE OH
43410-1215
US

V. Phone/Fax

Practice location:
  • Phone: 419-547-7787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number902
License Number StateOH

VIII. Authorized Official

Name: DR. GREGG S GRIFFIN
Title or Position: PRESIDENT
Credential: DC
Phone: 419-547-7787